This is the second post in our blog series called "The Quest for Quality", you can view our first post here.
On February 17, 2009, President Barack Obama signed the American Recovery and Reinvestment Act. It included the Health Information Technology for Economic and Clinical Health (HITECH) Act which allocated $19.2 billion to stimulate the development of a nationwide network of electronic health records (EHRs).
With a stroke of a pen, the US government laid the groundwork to change American healthcare fundamentally. This change has created the need for a whole new type of healthcare leader within health systems and physician groups – the QUALITY HERO! These heroes quickly found that although EHRs laid a foundation for measuring and improving quality, they were built during a soon-to-be-gone era of paying for healthcare services without regard for the quality of service and outcome (aka fee for services). Overwhelmingly, we’ve heard our heroes say their EHR’s utility for improving and managing quality of care is terribly limited.
Quality heroes are struggling to adapt during the shift to value-based care. At Avhana, we strive to support these heroes and help them improve care for hundreds of thousands (and soon millions!) of patients per year.
Typical challenges we hear from our quality heroes:
EHRs were not designed for improving or managing care quality
Quality care guidelines change rapidly and are impossible to keep up with
Quality tools should be systematic and scalable, yet flexible enough to address variable needs of care teams and patients at the local level
EHRs were not designed for managing care quality.
EHRs were built to replace file folders - then track and charge for the work being done by individual physicians. Most EHRs are built on a technical foundation from the 1980s & 90s when healthcare services were paid for regardless of quality and patient outcome. They are sophisticated billing systems designed around singular patient encounters. They are incredibly efficient at storing and retrieving information but cannot connect and generate insights from that information, especially across groups of people or larger populations.
As discussed in a previous post, quality heroes have found that quality improvement (and management) by one member of the care team at sporadic points in the clinical workflow is not practical. Every care team member should help to improve quality throughout a patient’s clinical journey. This requires EHRs to connect the right information for the right member of the care team at the right time. EHRs are structurally not set up to do this.
Guidelines are ever-changing and increasing in number
Clinical practice guidelines are changing at an accelerated pace and increasing in number as the volume of healthcare data exponentially increases. 5800 medical journals generate ~800,000 articles PER YEAR and growth of that data is accelerating. We hear every week in the news about a new or updated guideline. Here are just a couple of examples of long-accepted guidelines that have recently changed: aspirin and breast cancer screening.
At the same time, there may be different variations of one guideline that providers need to follow. For example, different health plans may choose different variations of a guideline and expect providers caring for their members to follow these changes.
Quality tools should be systematic & scalable, yet flexible
Quality heroes have realized that improving quality of care for an individual meant coordinating their care across multiple physicians, hospitals, and other allied care providers. This led health systems to the broad-scale acquisition of independent physician groups and allied care providers (e.g., skilled nursing facilities and physical therapy clinics).
Now, our heroes must improve the quality of care across multiple EHRs and hundreds of care sites. They need tools that can systematically identify gaps in care for individual patients but scale across their organization. This has been especially tough for managing care in the ambulatory setting, where over 80% of patient care takes place.
Most quality improvement tools have been designed for a narrow set of use cases and are therefore not applicable across an entire health system. When you mix in the rapid change and number of quality guidelines, this makes systematic and scalable quality improvement still very elusive for our quality heroes.
Quality Heros to the Rescue
At health systems and physician groups who have been preparing for a new future in healthcare, there is always a quality hero (and most often many of them). This person recognizes and adapts to the above challenges and guides their colleagues toward thriving in an era of value-based care.
They recognize that so many of the processes around them need to be changed, but it's an uphill battle.
They work tirelessly with clinical leadership to prioritize care guidelines and enable providers to follow them.
They work with their EHR team on reconfiguration and add-ons to improve and manage care quality.
And they know the definitions of quality care are constantly changing – so what works today may not work tomorrow and will likely change in the future.
We’re just getting started
We started our journey of supporting quality heroes several years ago. As you may be shocked to learn, getting EHRs on board with what we were doing was not an easy feat. Getting them to view us as partners and working with them to build out new data integrations took even more.
However, since 2018 when we started implementing our technology in large health systems, we have helped quality heroes and their colleagues improve and manage quality of care for over 55,000 patients. Over that span, we helped identify and close over 110,000 gaps of care. Later this year we are expected to cross the 500,000 and 1,000,000 patients and gaps of care respectively.
About Avhana Health
Our mission is to offer impactful, patient-specific support for healthcare teams. At the core of what we do is the Avhana Quality Improvement Software Suite which we embed into leading electronic health records (e.g. Allscripts, athenahealth, Cerner & Epic). Our team is located in Baltimore, Los Angeles, and Boston. Avhana Health was awarded “Best Provider Facing Company” during Health 2.0 in 2018.